Education  |   December 2016
Images in Anesthesiology: Skin Mottling after Induction
Author Notes
  • From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (E.E.N., W.C.L.); and Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts (L.S.O.).
  • Address correspondence to Dr. Naoum: enaoum@partners.org
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Critical Care / Hematologic System / Obstetric Anesthesia / Patient Safety / Pediatric Anesthesia
Education   |   December 2016
Images in Anesthesiology: Skin Mottling after Induction
Anesthesiology 12 2016, Vol.125, 1219. doi:10.1097/ALN.0000000000001216
Anesthesiology 12 2016, Vol.125, 1219. doi:10.1097/ALN.0000000000001216
ASCENDING skin mottling demonstrated in the presented image (fig.) was noted after induction of general anesthesia and positioning. The differential diagnosis included adverse drug reaction, hypothermia, ischemia, acute anemia, and sepsis. Patient survey revealed an irrigation bottle placed under the axilla of the operative limb to facilitate surgical prep as seen in the figure. Removal of the bottle resulted in immediate resolution of the mottling and a palpable radial pulse. Appropriate patient positioning is critical for patient safety in the operating room. Ischemic nerve damage occurs as a result of failure of blood flow to the neuron, resulting in metabolic stress that often presents as paresthesias.1 
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